5 erros do desígnio do web site de que enrola a marca da empresa

The Encounter Data Management Operating Model

Our Encounter Data Management Operating Model is a comprehensive roadmap to building a best-in-class encounter data management practice. Within this model all aspects of encounter data management are covered:

The result will be a sustainable ongoing encounter data management practice that you can trust to provide the highest quality encounter reporting.

[pwebcontact id=3]

UNDERSTANDING WHAT YOUR ENCOUNTER DATA IS SHOWING YOUR CUSTOMERS

Are your Encounter Data reflective of your true medical costs?
Are all diagnosis codes being sent appropriately?
Are you missing out on OB kick or high cost drug payments?
Can your data be trusted to create actuarially sound premium rates?
If you cannot answer these or many more similar questions in a positive way, it is critical that you quickly gain insight into your encounter data. EDRS can help you understand what your encounter data are showing your customers. Our Encounter Analytics will uncover any current deficiencies in your data. We perform a complete element by element check of the data that you submit, and we reconcile your submitted and accepted data to other financial reports such as Claim Lags and Provider Payments. We can help you find the value you have been missing from your encounter data.

[pwebcontact id=5]

ENCOUNTER RECONCILIATIONS

EDRS can help you build the same reconciliations that the states or their auditors are performing against your data so that you always know where you stand and can remediate problems before it is too late. We may also uncover issues with the financial reporting that could be incorrectly making your encounter data appear to be deficient. Or, as we have observed in some cases, the states or their auditors may have methodology issues with the reconciliation that need to be addressed.

[pwebcontact id=6]

RISK ADJUSTMENT

When pursuing retroactive risk adjustment opportunities, it is critical that these data be sent and accepted by the state agency. Every diagnosis code tracked down, but not sent and accepted, is a waste of time and money. We can help you build robust tracking that ensures that you get the most out of your risk adjustment efforts. Beyond that, we can also help you optimize how diagnostic information is submitted on your encounters. In several states, only the first few diagnosis codes on encounters submitted are captured within the state MMIS. Where allowable, we can help you build processes that look at a member’s diagnosis history and optimize diagnosis order on your encounters to ensure that all applicable disease bands are reported.

[pwebcontact id=7]

CONTRACT COMPLIANCE

The four major items most contracts require are Timeliness, Accuracy, Completeness, and Remediation. We can help you build the operational reporting needed to track these and other metrics. In order to fully meet your contract’s requirements, you have to know where the status of these metrics stand each and every day.

[pwebcontact id=8]

Delegated Vendors

You need to be assured that your vendors are providing you all the encounter data necessary, and in a manner that meets the specific state requirements. We can help build reconciliation processes that let you know what is received, what should have been received, and where the problems that need attention are located. We can also help you develop the standard terms for vendor contracts that hold them accountable for full and accurate encounter reporting.

[pwebcontact id=9]

REVENUE PARITY

EDRS can help you examine all of the necessary “cluster” elements within your EDPS submissions, making sure that what you report on RAPS is present on EDPS. We can help you build reconciliations between the two data sets that allow you to know what impacts this transition may have to your revenue. EDRS can also help you build operational reporting specific to Medicare Advantage needs. Knowing the potential loss of risk score due to encounter issues will allow you to prioritize remediation work based on revenue impact.

[pwebcontact id=10]

Filtering Logic

EDRS can help you prepare to act so that once the final publication of these highly important items happens, you are ready to quickly understand the impacts. We can help you prepare by building custom analytics that allow for rapid modeling and scenario building against your current EDPS submissions. Don’t be caught off guard, be ready to act.